I think there are a few different layers to the problem. Most generally, in our sexist culture, women’s voices are not granted the same authority as men’s in a range of contexts, and this extends to our testimony about what’s happening in our own bodies.

I think it’s also clearly rooted in gender stereotypes that view men as stoic and women as more emotional when experiencing pain or other worrisome symptoms. There’s an expectation that men keep a stiff upper lip, so when they do seek medical care, their complaints are more likely to be taken seriously because they’re assumed to be reluctant to be admitting to being in pain to begin with. The fact that women are more culturally “permitted” to express pain seems to somehow lead (surely unconsciously, most of the time) to a contrasting stereotype that womenoverreport their pain or seek medical caretooreadily.

Most specifically, though, I think this tendency—which I describe as “the trust gap” in my book—is rooted in the legacy of the concept of “hysteria.” For centuries, “hysteria”—which is derived from the Greek word for uterus—was a diagnostic label applied to pretty much all of women’s mysterious symptoms. In ancient times, it was linked to a “wandering womb” and by the 17th and 18th centuries was started to be seen as a disorder of the nervous system. But after Freud, as psychiatry became its own speciality, there was a shift to viewing hysteria not as a physical disease but as a mental disorder that caused physical symptoms.

Ever since, medicine has retained this concept of “psychogenic” illness—symptoms thought to be “produced” by the “unconscious mind” in contrast to “organic” symptoms attributable to a physical disease. (Other labels that have been used over the years for allegedly psychogenic symptoms include somatization, somatoform symptoms, conversion disorder, and sometimes functional symptoms.) So often when women find their physical symptoms are dismissed as “depression,” “anxiety,” or “stress” or it is otherwise implied that the problem is “all in your head,” it’s this concept of hysteria that’s at play.

Women are especially vulnerable to this kind of psychologizing in part because the typical patient with “hysterical” symptoms has always been described as a woman in the medical literature. But it’s also because of the other big problem I discuss in my book: “the knowledge gap.” Thanks to a dearth of scientific research into their illnesses and bodies, women are more likely to have “medically unexplained symptoms”—symptoms and syndromes that medical science doesn’t fully understand in biological terms. And by and large, medicine has just assumed that any symptoms it can’t (yet) explain must, by default, be psychogenic. So the lack of knowledge about women’s health helps perpetuate this long-standing stereotype that women are particularly prone to hysterical symptoms.

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